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Koutp A, Hauer G, Leitner L, Kaltenegger L, Fischerauer S, Clar C, Reinbacher P, Schittek G, Leithner A, Sadoghi P. Less Induction Time and Postoperative Pain Using Spinal Anesthesia Versus General Anesthesia With or Without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:904-909. [PMID: 37852447 DOI: 10.1016/j.arth.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect. METHODS Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients). RESULTS We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05). CONCLUSIONS Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
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Affiliation(s)
- Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lucas Kaltenegger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefan Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Clemens Clar
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gregor Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Reinbacher P, Schittek GA, Draschl A, Hecker A, Leithner A, Klim SM, Brunnader K, Koutp A, Hauer G, Sadoghi P. Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years. J Clin Med 2023; 12:5088. [PMID: 37568489 PMCID: PMC10420252 DOI: 10.3390/jcm12155088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). METHODS Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. RESULTS Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. CONCLUSION Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Gregor A. Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Sebastian Martin Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Amir Koutp
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Georg Hauer
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Patrick Sadoghi
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
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Continuous Lumbar Plexus Block vs Continuous Lumbar Erector Spinae Plane Block for Postoperative Pain Control After Revision Total Hip Arthroplasty. Arthroplast Today 2021; 9:29-34. [PMID: 33997205 PMCID: PMC8099915 DOI: 10.1016/j.artd.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Optimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty. Material and methods We compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting. Results There was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively, P = .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively, P = .42). Conclusions There was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.
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Roebke AJ, Via GG, Everhart JS, Munsch MA, Goyal KS, Glassman AH, Li M. Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors. Bone Jt Open 2020; 1:398-404. [PMID: 33215130 PMCID: PMC7659675 DOI: 10.1302/2633-1462.17.bjo-2020-0025.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Garrhett G Via
- Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA
| | - Joshua S Everhart
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maria A Munsch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bagaria V, Kulkarni RV, Valavi A, Choudhury H, Dhamangaonkar A, Sahu D. The feasibility of direct adductor canal block (DACB) as a part of periarticular injection in total knee arthroplasty. Knee Surg Relat Res 2020; 32:48. [PMID: 32958074 PMCID: PMC7507271 DOI: 10.1186/s43019-020-00066-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adductor canal block (ACB) is one of the preferred methods of analgesia in total knee arthroplasty (TKA). However, conventionally its use is time-consuming, requires ultrasound guidance, a trained anaesthesia team and adherence to strict asepsis by members of the allied teams. This study was done to assess the feasibility and safety of direct adductor canal block (DACB) as a part of surgeon-administered periarticular infiltration. MATERIALS AND METHODS Thirty computed tomography (CT) angiography films of the patients were retrospectively reviewed. The trajectory of the needle placement for a DACB in relation to the target region of the adductor block was determined. Fourteen knees in seven cadavers, were dissected through a medial parapatellar approach to perform TKA. After administering the DACB using the technique based on CT data, dissection was carried out to ascertain the correct placement of the dye by visualising the stained areas. RESULTS The angle of approach in the coronal plane from the entry point to the medial high point and to the adductor hiatus was 10.2° (8-14°) and 6° (3.8-11°), respectively. The angle of approach in the sagittal plane from the entry point to the medial high point and to the adductor hiatus was 7° (5-10.5°) and 29° (19-43°), respectively. In all the 14 cadaveric knees, we confirmed the correct placement of the methylene blue dye as demonstrated by the staining of the adductor canal. CONCLUSION The study demonstrates the feasibility of the DACB. This surgeon-driven technique is likely to reduce the cost of the procedure, reduce operating room time and also eliminate the risks of surgical-site contamination.
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Affiliation(s)
- Vaibhav Bagaria
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Rajiv V Kulkarni
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Anisha Valavi
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Himanshu Choudhury
- Department of Radiology, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai, India
| | | | - Dipit Sahu
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Mumbai, India.
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Stundner O, Poeran J, Ladenhauf HN, Berger MM, Levy SB, Zubizarreta N, Mazumdar M, Bekeris J, Liu J, Galatz LM, Moucha CS, Memtsoudis S. Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study. Reg Anesth Pain Med 2019; 44:565-572. [PMID: 30867279 DOI: 10.1136/rapm-2018-100145] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/21/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The significance of intravenous over oral acetaminophen (APAP) as part of multimodal analgesic protocols is contested, particularly when considering its relatively high price and use in a surgical cohort such as total hip or knee arthroplasty (THA/TKA), which generally tolerates oral medications. This study aims to elucidate APAP's effectiveness in a large, population-based patient sample. METHODS 1 039 647 THA/TKA procedures were sampled from the Premier Healthcare claims database 2011-2016. APAP use was categorized by intravenous/oral and use on the day of surgery, postoperative day 1 and thereafter. Outcomes were opioid utilization (in oral morphine equivalents), length and cost of hospitalization, and opioid-related adverse effects (respiratory, gastrointestinal, and naloxone use as a proxy). Mixed-effects models measured the associations between intravenous/oral APAP use and outcomes. Percent (%) change and 95% CIs are reported. RESULTS Overall, 23.6% (n=245 454) of patients received intravenous APAP; of these, 56.3% (n=138 180) received just one dose on the day of surgery. After adjustment for relevant covariates, particularly use of >1 dose of intravenous APAP (compared with no use) on postoperative day 1 was associated with -6.0% (CI -7.2% to -4.7%) reduced opioid utilization; this was -10.7% (CI -11.4% to -9.9%) for use of > 1 dose oral APAP on postoperative day 1. Further comparisons regarding other outcomes also favored oral (over intravenous) APAP. CONCLUSIONS These results do not support the routine use of intravenous APAP in patients undergoing lower joint arthroplasty, especially since oral APAP shows more beneficial outcome patterns.
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Affiliation(s)
- Ottokar Stundner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA .,Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Noemi Ladenhauf
- Department of Pediatric and Adolescent Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Marc Moritz Berger
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Steven B Levy
- Department of Pharmacy, Mount Sinai St Luke's, Mount Sinai Health System, New York, New York, USA
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Janis Bekeris
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria.,Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Calin S Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stavros Memtsoudis
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria.,Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
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Postoperative outcomes with neuraxial versus general anesthesia in bilateral total hip arthroplasty. J Clin Anesth 2019; 52:71-75. [DOI: 10.1016/j.jclinane.2018.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/23/2018] [Accepted: 09/08/2018] [Indexed: 12/11/2022]
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Runge C, Bjørn S, Jensen JM, Nielsen ND, Vase M, Holm C, Bendtsen TF. The analgesic effect of a popliteal plexus blockade after total knee arthroplasty: A feasibility study. Acta Anaesthesiol Scand 2018; 62:1127-1132. [PMID: 29797704 DOI: 10.1111/aas.13145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION An obturator nerve block (ONB) and a femoral triangle block (FTB) provide effective analgesia after total knee arthroplasty (TKA) without impeding the ambulation, although the ONB produces motor blockade of the hip adductor muscles. The popliteal plexus (PP) in the popliteal fossa is formed by contribution from the tibial nerve and the posterior obturator nerve, innervating intraarticular genicular structures and the posterior capsule of the knee. We hypothesised that a popliteal plexus block (PPB) as a supplement to an FTB would reduce pain after TKA without anaesthetising motor branches from the sciatic nerve in the popliteal fossa. AIM To assess the analgesic effect of adding a PPB to an FTB in 10 subjects with significant pain after TKA. METHODS All subjects underwent unilateral TKA with spinal anaesthesia and received an FTB. The cutaneous sensation and the postoperative pain were assessed. The primary outcome was the proportion of subjects with pain above numeric rating scale (NRS) 3 followed by a reduction to NRS 3 or below after conducting a PPB. RESULTS Ten subjects with a median pain of NRS 5.5 (interquartile range [IQR] 4-8) after unilateral TKA received a PPB. All 10 subjects experienced a reduction in pain to NRS 3 or below (NRS 1.5 [IQR 0-3]) within a mean time of 8.5 (95% CI 6.8-10.2) minutes. Three subjects were completely pain free after the PPB. The ankle muscle strength was not affected. CONCLUSIONS The PPB provided effective pain relief without affecting the ankle muscle strength in all 10 subjects with significant pain after TKA and an FTB.
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Affiliation(s)
- C Runge
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - S Bjørn
- Aarhus University, Aarhus, Denmark
| | - J M Jensen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - N D Nielsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - M Vase
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - C Holm
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - T F Bendtsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
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Picard F, Niddam J, De Runz A, Chaouat M, Mimoun M, Boccara D. Intraoperative instillation of ropivacaine during the placement of sub-muscular cosmetic breast implants: Is there a clinical benefit? ANN CHIR PLAST ESTH 2017; 63:20-24. [PMID: 29032877 DOI: 10.1016/j.anplas.2017.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery. MATERIAL AND METHODS We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time. RESULTS Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05). CONCLUSION Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- F Picard
- Plastic and reconstructive surgery, hôpital Henri-Mondor, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - J Niddam
- Plastic and reconstructive surgery, hôpital Henri-Mondor, 51, avenue du Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - A De Runz
- Plastic and reconstructive surgery, CHRU de Nancy, 29, avenue du Marechal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - M Chaouat
- Plastic and recontructive surgery, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Mimoun
- Plastic and recontructive surgery, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Boccara
- Plastic and recontructive surgery, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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